PB2432: MULTIPLE MYELOMA TRANSPLANT DATABASE IN PATIENTS OVER THE AGE OF 65: A SINGLE CENTRE RETROSPECTIVE COHORT ANALYSIS
Authors: Janet Tan, Charlotte O’sullivan, Teresa Meenaghan, Carina Meyer, Yizel Paz Nunez, Niamh Keane
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: Multiple myeloma is a heterogenous haematological malignancy with an incidence of approximately 5 per 100,000 per year in Ireland. Over the past two decades, autologous stem cell transplant (ASCT) has been the gold standard in the management of multiple myeloma, leading to improved overall survival. However, there is limited data to assess the role of autologous stem cell transplant in patients above the age of 65. Aims: The objective of this study is to assess the clinical outcomes of multiple myeloma patients (over the age of 65) post autologous stem cell transplant. Methods: We conducted a retrospective cohort analysis on multiple myeloma patients over the age of 65 who underwent autologous stem cell transplant in Galway University Hospital, Republic of Ireland from 2005 to 2022. Date collection was performed using the Galway Blood and Tissue Establishment (GBTE) records, patient information system (MOSAIQ, EVOLVE) and the hospital laboratory system. We looked into the patients’ myeloma history, premorbid status and clinical outcome post stem cell transplant. The information was subsequently collated into a spreadsheet and data analysis was performed. Results: A total of 107 patients were identified. From the patients’ demographics perspective, 66 were male patients (61% of patient cohort) and the oldest patient who underwent ASCT was 72 years of age. 79% of patients had a Charles comorbidity index of 1 to 2. Prior to stem cell transplant, CyBORD (combination of Cyclosphosphamide, Bortezomib and dexamethasone) regimen was the induction therapy of choice until 2019. This was subsequently transitioned to RVD (Lenalidomide, velcade and dexamethasone). The mean time to engraftment post stem cell infusion is 11 days and 63% of patients developed febrile neutropenia in the process. The longest inpatient admission noted was 81 days due to neutropenic colitis complicated by small bowel obstruction. Post autologous stem cell transplant, 52 % of patients proceeded to maintenance therapy with the majority receiving lenalidomide monotherapy. 16 out of 107 patients relapsed and there is a significant variation in the duration of remission ranging between 6 months to 11 years. We note that 3 patients subsequently developed therapy related myeloid neoplasms. 47% of patients are alive to date. Summary/Conclusion: From this analysis, there is 65% 10-year survival rate in this cohort of patients post autologous stem cell transplant. Majority of these patients have a comorbidity index of 1 to 2 pre-transplant. Half of these patients proceeded to maintenance therapy, 15% relapsed and there is variable duration of remission. Interestingly, there is a population of patients who developed therapy related myeloid neoplasms post-transplant. Further studies would be required to assess the pathophysiology and prevalence for the same. Keywords: Multiple myeloma